Tell me your experience as a PNP

[Nurse.Kelsey, BSN, RN]

Hello! I am planning on applying to NP school and I want to specialize in pediatrics. I currently work in peds hem/onc.

I wanted to be able to speak with Pediatric NPs about their job roles.

I encourage everyone to share how they like their job, what level of acuity they work in, what a day-in-the-life looks like and so forth.

Please share! :) I appreciate it!

[babyNP., APRN]

I haven't seen many (if any?) PNP posters here on allnurses. Maybe you can ask the PNPs at your facility? Keep us posted on your journey and best of luck.

[LovingPeds, MSN, APRN, NP]

I am a Acute/Primary Care PNP. I currently work in a doctor's office. I am two years post-grad and was fortunate to find a supportive group of doctors. Prior to that I worked as a RN under several PNPs in an acute care setting. I work in a state where we have collaborative practice and where scope of practice is relatively limited for NPs in general. In an acute care setting, most NPs at the children's hospitals in my state function similarly to residents and help to extend the services of the physician.

I work in an impoverished rural area (the UN called it third world when they toured the area) where we see a lot of interesting cases due to the lack of resources in reaching health care. The acuity of the patients I currently see is relatively low to moderate. We do a lot of well child check-ups and anticipatory guidance. We do a lot of education with adolescents as well as screenings for STDs, birth control, etc. We do see sick children. Some of the more common things we see are rashes, fever, OM, viral illness, and leukocytosis with or without a known cause. We follow patients with chronic illness and make referrals to specialties as needed and we follow the recommendations of those specialties as required. The office I work at has the capabilities to do common in-house labs and x-rays and part of my job is initial interpretation of that.

The job varies by state and facility. My practice may be fairly unusual for an NP. I start by seeing the patient on my own, order labs / x-rays as needed, formulate my diagnoses, and then present it as a case to the physician. The physician then sees the patient to confirm they have no further questions or that my diagnosis was correct. I then prescribe the medication and complete the visit note. Medications are pretty much prescribed and refilled at my discretion. I literally function the same as the residents that they are in the process of training and it is very similar to the function of PNPs in acute care in my state. This may would bother some, but the physicians I work with have over 100 years combined experience in peds so I'm taking the opportunity to soak up the knowledge.

I have worked with primary care PNPs that worked independently as well and I have the chance to work independently at my practice when one or more physicians takes a vacation. The day basically goes the same way with the exception you cut out the formulation and presentation of the case.

I love my job. I plan to stay for several years to gather more experience and training. I will probably eventually branch out to another area if I'm not given more independence in practice with continued experience.

[adventure_rn, MSN, NP]

8 hours ago, LovingPeds said:

I am a Acute/Primary Care PNP.

Was there any particular reason you got the dual certification? It seems like kind of a hassle, both to complete and to maintain. Still, there's something pretty appealing about being able to work in literally any peds practice setting.

[LovingPeds, MSN, APRN, NP]

1 hour ago, adventure_rn said:

Was there any particular reason you got the dual certification? It seems like kind of a hassle, both to complete and to maintain. Still, there's something pretty appealing about being able to work in literally any peds practice setting.

I chose the dual because I wanted to be able to work in a primary care setting and to be able to round on those patients in an acute care setting. I am located hours away from a children's hospital where you might have full-time acute care practitioners or a pediatric hospitalist. Most of the physicians in this area admit their patients and then make rounds themselves. It has just worked out that my current employer doesn't need this due to the residents they are training at the hospital so I function strictly primary care.

This was an extra year of school for me and an extra certification examination (neither is cheap). The renewal of that certification is thankfully offered in a combined format so, while there is more to complete, it's not unmanageable. You can find more about certification and renewal at PNCB.org. Most PNPs are certified through them.

That being said, the nurse practice act in my state does not require that pediatric NPs have an acute care certification in order to care for patients inpatient due to the fact that pediatrics in general is so 'specialized'. I knew this before starting my degree. I worked with many PNPs who only had or maintained a primary care NP over the years who took care of patients while they were hospitalized. They did this with varying levels of comfort. One was a school nurse who had not worked acute care prior to her NP. She was admittedly uncomfortable with inpatient care even though her care honestly was quite competent for the level of acuity of the patients. Another worked acute care for years before becoming an NP and was quite at home with inpatient care.